Achilles tendinitis is very
common among running athletes. The calf muscles attach to the calcaneus via the Achilles tendon. During running, the calf muscles help with the lift-off phase of gait. Repetitive forces from running
combined with insufficient recovery time can initially cause inflammation in the tendon paratenon (fatty areolar tissue that surrounds the tendon). A complete tear of the Achilles tendon is a serious
injury, usually resulting from sudden, forceful stress. Tendon tears can occur with minimal exertion in people who have taken fluoroquinolone antibiotics.
The cause of paratenonitis is not well understood although there is a correlation with a recent increase in the intensity of running or jumping workouts. It can be associated with repetitive
activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear and training issues such as running on uneven or excessively hard ground or running
on slanted surfaces. Tendinosis is also associated with the aging process.
The pain associated with Achilles tendonitis can come on gradually or be caused by some type of leg or foot trauma. The pain can be a shooting, burning, or a dull ache. You can experience the pain at
either the insertion point on the back of the heel or upwards on the Achilles tendon within a few inches. Swelling is also common along the area with the pain. The onset of discomfort at the
insertion can cause a bump to occur called a Haglund's deformities or Pump bump. This can be inflammation in the bursa sac that surrounds the insertion of the Achilles tendon, scar tissue from
continuous tares of the tendon, or even some calcium buildup. In this situation the wearing of closed back shoes could irritate the bump. In the event of a rupture, which is rare, the foot will not
be able to go through the final stage of push off causing instability. Finally, you may experience discomfort, even cramping in the calf muscle.
To confirm the diagnosis and consider what might be causing the problem, it?s important to see your doctor or a physiotherapist. Methods used to make a diagnosis may include, medical history,
including your exercise habits and footwear, physical examination, especially examining for thickness and tenderness of the Achilles tendon, tests that may include an x-ray of the foot, ultrasound
and occasionally blood tests (to test for an inflammatory condition), and an MRI scan of the tendon.
Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be
carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. Occasionally a walking boot or cast may be recommended to
immobilize the tendon, allowing the inflammation to settle down. For less severe cases or after immobilization, a heel lift may be prescribed to reduce stress to the tendon. This may be followed by
an elastic bandage wrap of the ankle and Achilles tendon. Orthotics (arch supports) may be prescribed or recommended by your physician. Surgery to remove the inflamed tendon lining or degenerated
tendon tissue is rarely necessary and has shown less than predictable results.
It is important to understand that surgery may not give you 100% functionality of your leg, but you should be able to return to most if not all of your pre-injury activities. These surgical
procedures are often performed with very successful results. What truly makes a difference is your commitment to a doctor recommended rehabilitation program after surgery as there is always a
possibility of re-injuring your tendon even after a surgical procedure. One complication of surgical repair for Achilles tendon tear is that skin can become thin at site of incision, and may have
limited blood flow.
Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which
originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg
before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the
connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer
toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it
shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the
Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.